Materiały źródłowe

• #1 Pneumonitis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pneumonitis/symptoms-causes/syc-20352623

  Pneumonitis is a result of an extra strong defense response by the body’s immune system to an irritating substance. […] Treatment focuses on avoiding irritants and lessening the inflammation of lung tissue. […] If pneumonitis is not detected or not treated, you may gradually develop lung damage that can’t be reversed.

• #2 Pneumonitis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/24810-pneumonitis

  Pneumonitis is inflammation in your lung tissue. Healthcare providers can treat pneumonitis, but long-term inflammation can cause irreversible lung damage. […] If you have pneumonitis, the best way to treat it is to avoid its cause. Your provider may also recommend the following medications or treatments: Corticosteroids or immunosuppressants. These medications help reduce lung inflammation. Your provider may prescribe prednisone, mycophenolate or azathioprine. Antifibrotic drugs. Antifibrotic drugs help slow down scarring in your lungs. Your provider may prescribe pirfenidone or nintedanib. Pulmonary rehabilitation. During pulmonary rehabilitation, you and a healthcare provider will work together to create an exercise program to help increase your lung strength. Oxygen therapy. Oxygen therapy helps provide your body with oxygen when breathing is difficult. You may need oxygen therapy at all times or only need it during certain activities, such as exercising or sleeping. Lung transplant. In severe cases of pneumonitis that progress to pulmonary fibrosis, your provider may recommend replacing one or both of your lungs with a donors healthy lungs.

• #3 Pneumonitis | Diagnosis & Disease Information – Pulmonology Advisor

  https://www.pulmonologyadvisor.com/ddi/pneumonitis/

  Pneumonitis refers to inflammation or irritation of the lungs that is triggered by allergens, environmental irritants, radiation therapy for cancer, and certain medications. Patients with pneumonitis experience shortness of breath, a dry cough, and chest pain. […] Swift diagnosis and treatment are imperative to preventing long-term damage. […] Treatment depends on the type pneumonitis but generally involves avoiding the triggering allergen or irritant, and anti-inflammatory therapy. Patients with chronic pneumonitis and pulmonary fibrosis generally require antifibrotic therapy, and in severe cases, may need a lung transplant. […] Patients with hypersensitivity or chemical pneumonitis should avoid or limit exposure to the allergens or irritants. While this may not be entirely possible for individuals with certain occupations, those who work in environments that expose them to potentially triggering substances should wear appropriate personal protective equipment.

• #4 Pneumonia Treatment and Recovery | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/pneumonia/treatment-and-recovery

  Treatment for pneumonia depends on the type of pneumonia you have, how sick you are feeling, your age, and whether you have other health conditions. The goals of treatment are to cure the infection and prevent complications. It is important to follow your treatment plan carefully until you are fully recovered. […] Take any medications as prescribed by your doctor. If your pneumonia is caused by bacteria, you will be given an antibiotic. It is important to take all the antibiotic until it is gone, even though you will probably start to feel better in a couple of days. If you stop, you risk having the infection come back, and you increase the chances that the germs will be resistant to treatment in the future. […] Typical antibiotics do not work against viruses. If you have viral pneumonia, your doctor may prescribe an antiviral medication to treat it. Sometimes, though, symptom management and rest are all that is needed.

• #5 Pneumonitis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/24810-pneumonitis

  With early diagnosis and treatment, the outlook for pneumonitis is good. If you have acute pneumonitis, your symptoms may go away within a few days after removing the irritant from your environment. Chronic pneumonitis damage is usually permanent. However, medication and therapy can help reduce the severity of your symptoms.

• #6 Hypersensitivity Pneumonitis: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17898-hypersensitivity-pneumonitis

  Lung transplant. If your HP progresses to pulmonary fibrosis, you may need a lung transplant. […] It can take several months for your lungs to heal from the inflammation HP causes. Some damage can be permanent. […] You usually cant get rid of chronic hypersensitivity pneumonitis. Acute and subacute HP can go away on its own or with medication if you arent exposed to the allergen anymore.

• #7 Treating and Managing Hypersensitivity Pneumonitis | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/hypersensitivity-pneumonitis/treating-and-managing

  Once hypersensitivity pneumonitis is diagnosed, if you can identify the allergen that is causing your reaction, the single most important thing you can do is avoid it. Talk to your doctor about steps you will need to take to avoid or eliminate the allergen from your home or workplace. If your illness is caught early, staying away from the source can help completely reverse the damage and, after a short time, your lungs will return to normal. […] In more severe cases, avoidance may not be enough. Then, treatment may include corticosteroids or other immunosuppressive medication to reduce inflammation and prevent your immune system from reacting to the allergens you inhale. You may be required to take this medication for up to three months and sometimes longer depending on severity. You may also require supportive therapies such as bronchodilators, which relax your airways to make breathing easier or oxygen therapy, which can raise oxygen levels in your blood. […] If you are still experiencing symptoms, your doctor may suspect advanced scarring and recommend a lung transplant. Unfortunately, this is not a cure and patients will still require further care to avoid exposure and ensure that the inflammation does not continue and damage the new lung.

• #8 Clinical Management of Pneumonitis in Patients Receiving Anti–PD-1/PD-L1 Therapy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6347088/

  A 48-year-old gentleman with metastatic melanoma currently receiving the cytotoxic T-lymphocyteassociated antigen 4 (CTLA-4) inhibitor, ipilimumab (Yervoy), and the programmed cell death protein 1 (PD-1) inhibitor, nivolumab (Opdivo), returned for evaluation prior to receiving cycle 2. […] Based on his presentation and CT findings, the patient was initially treated empirically with antibiotics for suspected pneumonia vs. pneumonitis. […] After the administration of steroids, the patients cough and breathing improved and he remained afebrile, eliciting a high suspicion for immune-related pneumonitis. […] The patient then underwent bronchoscopy to rule out other etiologies. […] The algorithms indicate that the treatment of patients with grade 3 (severe) or grade 4 (life-threatening) toxicity should include infectious disease and pulmonary consultations for further evaluation and bronchoscopy.

• #9 Hypersensitivity Pneumonitis: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17898-hypersensitivity-pneumonitis

  To successfully treat hypersensitivity pneumonitis, you have to stay away from the cause. […] Even with medication, HP wont go away completely if you continue to breathe in the allergen. Chronic HP causes damage that may get worse even if you arent exposed to the allergen anymore. […] Your provider may prescribe drugs to reduce inflammation, open your airways or increase your oxygen levels. […] Corticosteroids or immunosuppressive medications. These medications help reduce inflammation. Specific drugs could include prednisone, mycophenolate or azathioprine. […] Anti-fibrotic drugs (pirfenidone and nintedanib). These medications can slow lung scarring. […] Pulmonary rehabilitation. Breathing exercises and physical therapy can help make breathing easier. […] Oxygen therapy. If you have severe HP, you may need extra oxygen to make sure your blood or tissues are getting enough. Its delivered through a mask on your face or a tube in your nose.

• #10 Pneumonitis | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/pneumonitis?content_id=CON-20303988

  Treatment focuses on avoiding irritants and lessening the inflammation of lung tissue. […] If you have pneumonitis caused by chemical irritation or an allergic reaction, your healthcare professional will likely recommend stopping the exposure that’s irritating your lungs. This step should help lessen your symptoms. […] Corticosteroid medicines work by calming your immune system’s reaction to an irritation. This can make your lungs less inflamed. Corticosteroids are usually taken as a pill for a limited time. […] Sometimes corticosteroids using an inhaler may help. You breathe these medicines into your lungs. The medicines lessen inflammation in your airway so that it’s easier to breathe. […] Treatment for pneumonitis caused by medicines depends on how severe symptoms are. If symptoms are mild, you may not need any treatment. If your symptoms are severe, treatment with mainly corticosteroids, but sometimes other medicines that lessen your immune system’s reaction, may help.

• #11 Pneumonitis: Symptoms, Causes, and More

  https://www.healthline.com/health/pneumonitis

  Pneumonitis is treatable. However, it can cause permanent scarring and lung damage if you dont catch it early enough. […] The best way to relieve your symptoms is to avoid the substance that triggered them. If you work around mold or bird feathers, you may need to change jobs or wear a mask. […] The following treatments can relieve pneumonitis symptoms, but they wont cure the disease: Corticosteroids: Prednisone (Rayos) and other steroid drugs bring down inflammation in your lungs. Side effects include weight gain and an increased risk for infections, cataracts, and weakened bones (osteoporosis). […] Oxygen therapy: If youre very short of breath, you can breathe in oxygen through a mask or prongs in your nose. […] Bronchodilators: These medicines relax the airways to help you breathe easier. […] If your lung is so severely damaged that you cant breathe well even with treatment, you may be a candidate for a lung transplant. Youll have to wait on an organ transplant list for a matched donor.

• #12 Pneumonitis.: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/pneumonitis

  Management of pneumonitis includes avoidance of any established precipitating cause. […] Treatment of pneumonitis depends on the underlying cause and may include medications such as systemic corticosteroid therapy, which can speed resolution of hypersensitivity pneumonitis. […] Antibiotics for infection. […] Anti-fibrotic drugs (showing promising results in the treatment of idiopathic pulmonary fibrosis).

• #13

  https://link.springer.com/article/10.1007/s11864-024-01257-6

  Treatment of pulmonary toxicities associated with EGFR-TKI therapy is not established and is dependent on grade and severity of symptoms. Management includes holding the offending EGFR-TKI agent and the administration of corticosteroids. […] Similarly to EGFR-TKIs, treatment of pulmonary toxicities associated with Amivantamab includes holding the drug and administration of corticosteroids. […] In our current clinical practice, we utilize a multi-disciplinary approach in management of irAEs that includes a medical and radiation oncologist, radiologist, pulmonologist, pharmacist, palliative care practitioner, oncology nursing specialist, and social worker. […] Most cases of pneumonitis are treatable with holding of the culprit drug and use of corticosteroids.

• #14 Pneumonitis | Diagnosis & Disease Information – Pulmonology Advisor

  https://www.pulmonologyadvisor.com/ddi/pneumonitis/

  To treat patients with drug-induced pneumonitis, drug therapy should be discontinued and replaced with an appropriate alternative when possible. Acute symptoms should resolve within 48 to 72 hours of discontinuing the medication. Patients with more severe cases may benefit from treatment with corticosteroids. […] Patients with drug-induced pneumonitis may receive corticosteroid therapy, such as prednisone 1 to 2 mg/kg/d or methylprednisolone 0.5 to 1 mg/kg/d for individuals with mild to moderate cases. Patients with severe cases may need to be hospitalized and treated with high-dose corticosteroids and additional immunosuppression, including mycophenolate mofetil, cyclophosphamide, or infliximab.

• #14 Pneumonitis | Diagnosis & Disease Information – Pulmonology Advisor

  https://www.pulmonologyadvisor.com/ddi/pneumonitis/

  Due to limited evidence, there are no guidelines for the pharmacologic treatment of hypersensitivity pneumonitis. Patients who continue to experience clinically significant symptoms despite efforts to avoid or remediate the triggering allergen or irritant are commonly treated with corticosteroids. The goal is to reduce inflammation and prevent progression to pulmonary fibrosis. […] In patients with chronic disease that has progressed to pulmonary fibrosis, antifibrotic therapies, such as nintedanib or pirfenidone, are recommended. Immunosuppressive regimens with steroid-sparing agents such as azathioprine or mycophenolate mofetil may also be appropriate. […] Radiation pneumonitis often manifests in the weeks or months following radiation therapy. The extent of inflammation is directly correlated with the radiation dose. Patients with mild symptoms can be treated with 800 g of inhaled budesonide twice a day for 14 days. If symptoms persist, inhaled corticosteroid treatment can continue for several months.

• #15 Drug-Related Pneumonitis in the Era of Precision Cancer Therapy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7446404/

  A recently published guideline of pneumonitis management is in agreement with the observations in these reports. […] The guideline recommends oral corticosteroid treatment, including prednisone 1 to 2 mg/kg/d or methylprednisolone 0.5 to 1 mg/kg/d in mild to moderate cases. […] In severe cases, hospitalization is necessary, with treatment to include high-dose corticosteroids, such as methylprednisolone 2 to 4 mg/kg/d, and additional immunosuppression, including mycophenolate mofetil, cyclophosphamide; infliximab can be administered if necessary. […] Although limited to a small percentage of patients, an additional unique phenomenon of pneumonitis flare has been reported where ICI-related pneumonitis recurs after the termination of corticosteroid taper and in the absence of ICI retreatment after the initial episode of pneumonitis has been successfully treated.

• #16 Azthena logo with the word Azthena

  https://www.news-medical.net/health/What-is-Pneumonitis.aspx

  Treatment guidance for pneumonitis is currently unavailable. While avoidance of the antigen is the most necessary step in treating hypersensitivity pneumonitis, absolute removal from the patients environment may not be possible. […] If complete avoidance of the antigen is not possible because it would result in a dramatic change in the patients lifestyle and/or occupation, corticosteroids may be prescribed. These medications can relieve acute symptoms but likely do not have any effect against the disease over the long term. Additionally, the evidence to support corticosteroid therapy for pneumonitis is weak. […] Oral prednisone therapy between 40 mg and 60 mg for a few days to 2 weeks could be prescribed for acute pneumonitis, whereas treatment may be needed for 4 to 8 weeks in patients with subacute or chronic forms of the disease. Other research suggests immunosuppressants may be helpful.

• #17 Hypersensitivity Pneumonitis – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/interstitial-lung-diseases/hypersensitivity-pneumonitis

  Treatment of acute or subacute hypersensitivity pneumonitis is with corticosteroids, usually prednisone 60 mg orally once a day for 1 to 2 weeks, then tapered over the next 2 to 4 weeks to 20 mg once a day, followed by weekly decrements of 2.5 mg until the drug is stopped. This regimen relieves initial symptoms but does not appear to alter long-term outcome. […] Treatment of chronic hypersensitivity pneumonitis is usually with longer courses of prednisone 30 to 40 mg orally once a day with tapering dependent on clinical response. Some patients require corticosteroid-sparing agents (eg, mycophenolate, azathioprine) for long-term treatment.

• #18 Pneumonitis – Wikipedia

  https://en.wikipedia.org/wiki/Pneumonitis

  Corticosteroid dose and treatment duration vary from case to case. However, a common regimen beginning at 0.5 mg/kg per day for a couple of days before tapering to a smaller dose for several months to a year, has been used successfully. […] Certain immune-modulating treatments may be appropriate for patients with chronic pneumonitis. Azathioprine and mycophenolate are two particular treatments that have been associated with an improvement of gas exchange. Patients with chronic pneumonitis also may be evaluated for lung transplantation.

• #19 Pneumonitis (St George’s Acute Oncology Service)

  https://www.stgeorges.nhs.uk/aos/st-georges-healthcare-professional/guidance/immunotherapy/pneumonitis/

  Discontinue immunotherapy if Grade 2 or above. […] If Grade 2: Start antibiotics as per hospital policy if concerned about infection (raised CRP/WCC, fever, septic). […] If no improvement on antibiotics after 48 hours or no evidence of infection: Bronchoscopy and after Start intravenous Methylprednisolone 10mg/kg/day x 3 (500/750/1000mg). […] If no improvement after 48 hours of oral steroids then manage as grade 3. […] Grade 3/4: IV Methylprednisolone as in Grade 2 followed by oral prednisolone starting at 0.5mg/kg/d and taper off. […] If no improvement or worsening after 48 hours, then discuss urgently with Respiratory to consider cyclophosphamide or other biologics Infliximab or mycophenolate (only after discussion with consultant oncologist).

• #20 Pneumonitis From Anti–PD-1/ PD-L1 Therapy

  https://www.cancernetwork.com/view/pneumonitis-antipd-1-pd-l1-therapy

  If the patient does not clinically improve within approximately 2 to 7 days of the start of corticosteroid administration, additional immunosuppressive medications may be considered (infliximab, cyclophosphamide, or mycophenolate mofetil); however, outcomes of these therapies have been variable in reported series. […] In selected cases, when corticosteroids are restarted or given over an extended taper, antimicrobial prophylaxis should be considered in accordance with local practices. […] Finally, after the acute treatment phase, along with CT imaging, pulmonary function tests (including carbon monoxide diffusion [DLCO] and spirometry) may be useful in tracking the response of the pneumonitis to immunosuppressive management. […] It is critical that patients be made aware of the possible signs and symptoms of pneumonitis to report to their providers, including new or worsening dyspnea on exertion, shortness of breath, cough, chest pain, and fever.

• #21 Steroid-refractory PD-(L)1 pneumonitis: incidence, clinical features, treatment, and outcomes | Journal for ImmunoTherapy of Cancer

  https://jitc.bmj.com/content/9/1/e001731

  Steroid-refractory ICI-pneumonitis constituted 18.5% of referrals for multidisciplinary irAE care. […] Patients treated with intravenous immunoglobulin had fewer fatalities (43%), improvements in patient oxygenation, and level-of-care. […] Published guidelines recommend a variety of potential treatments for steroid-refractory ICI-pneumonitis including infliximab, intravenous immunoglobulin (IVIG), cyclophosphamide, or mycophenolate mofetil. […] Our study is the first to demonstrate that IVIG may be used successfully to treat steroid-refractory ICI-pneumonitis in multiple patients; with only one prior study in which a single case of steroid-refractory ICI-pneumonitis demonstrated improvement with IVIG. […] Importantly, patients treated with IVIG both demonstrated improvement in their oxygen requirements and level-of-care and also had reduced fatalities from steroid-refractory ICI-pneumonitis, while those treated with an infliximab-containing regimen had poorer outcomes.

• #22 Pneumonitis | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/pneumonitis?content_id=CON-20303988

  If symptoms are mild, you may not need treatment for radiation pneumonitis. Severe symptoms are usually treated with corticosteroids. […] When pneumonitis is severe, treatment also may include: Oxygen therapy. If you’re having a lot of trouble breathing, you may need oxygen therapy through a mask or through a plastic tubing with tips that fit into your nose. […] Pulmonary rehabilitation can help manage your symptoms and improve your ability to do daily tasks. […] Severe lung damage may require a lung transplant.

• #23 Pneumonitis | OncoLink

  https://www.oncolink.org/support/side-effects/pulmonary-side-effects/pneumonitis

  Pneumonitis is managed by treating your symptoms. Pneumonitis can be prevented and chemotherapy and radiation should be given at the lowest but most effective doses. This will help lessen the harm to your lungs. […] Some ways that pneumonitis is managed are: Oxygen therapy to prevent a low level of oxygen in the body. Bronchodilators may be given to help open up the lungs for better oxygenation (oxygen flow). Steroids may be given to lessen inflammation and help the lungs heal. If you smoke, stop. Avoid places where people are smoking.

• #24 Hypersensitivity Pneumonitis Treatment & Management: Medical Care, Prevention

  https://emedicine.medscape.com/article/299174-treatment

  Treatment regimens for HP vary according to the prescriber. A conceivable initial empiric treatment dose is prednisone 0.5-1 mg/kg/day for 1-2 weeks in acute HP or 4-8 weeks for subacute/chronic HP followed by a gradual taper to off or maintenance dosage of approximately 10 mg/day. Continued therapy should be guided by clinical response, pulmonary function, and radiographic improvement. Maintenance doses are not always required, particularly if the patient is removed from exposure. […] Outside of oral corticosteroids, several other alternative therapies have been explored in select cases. Inhaled corticosteroids, bronchodilators, cromolyn sodium, and antihistamines may be helpful in cases with obstructive physiology with reversibility. The use of low-dose macrolide antibiotics have been suggested for inflammation reduction: however, beneficial effects have not been verified in human studies. The use of immunosuppressive agents such as azathioprine or cyclosporine has been documented in select pediatric cases but not in the adult population.

• #25 Pneumonitis: Symptoms, Causes, and Treatments

  https://resources.healthgrades.com/right-care/lungs-breathing-and-respiration/pneumonitis

  Pneumonitis treatment depends on the underlying cause. The goal is to reduce inflammation and prevent complications. Left untreated, the disease can become chronic. This can result in scarring and pulmonary fibrosis, which is irreversible lung damage. […] Treatment goals for pneumonitis are to reduce inflammation and prevent complications. An important step in this is to identify the irritant or allergen and avoid it. This could include needing to adjust conditions or techniques at work or with your hobby. An example might be to clean the humidification system of your house. These adjustments can help improve symptoms and reduce the risk of recurrences. […] To treat symptoms, doctors may also prescribe: Bronchodilators: These medications relax and open airways, which can ease breathing. Corticosteroids: These are strong anti-inflammatory drugs for short-term use. Immunosuppressants: These drugs stop your immune system from reacting to allergens. Oxygen therapy: This treatment provides supplemental oxygen to increase blood oxygen levels.

• #26 Pneumontis | Lung Care | Bon Secours

  https://www.bonsecours.com/health-care-services/lung-care-pulmonology/conditions/pneumonitis

  Pneumonitis is a lung condition that occurs when an irritant causes inflammation in the lungs. […] While there is not a specific cure for pneumonitis, you can relieve your symptoms with treatments. […] Treatments may include avoidance, medical management, oxygen therapy, bronchodilators, and as a last resort – lung transplant. […] Pneumonitis can be treated. If not treated early, it can cause severe lung scarring and damage. […] The most effective treatment for pneumonitis is avoidance. If you can avoid substances that trigger your symptoms, your symptoms can be relieved. If you have a job where you work around the irritating material, you may need to consider changing careers. […] While pneumonitis cannot be cured, treatments can help relieve your symptoms. […] Treatments include: corticosteroids, such as prednisone, can reduce your inflammation; oxygen therapy – oxygen therapy can help you breathe easier; a bronchodilator can help you breathe easier by relaxing the airways; lung transplant – lung transplant is the last resort option for patients with severely damaged lungs who cannot breathe well after other treatment options.

• #27 Hypersensitivity Pneumonitis | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/hypersensitivity-pneumonitis

  Hypersensitivity pneumonitis will often go away if the patient avoids the substance that’s triggering the lung inflammation. […] For patients who get worse despite treatment, lung transplantation may be an option. […] Treating hypersensitivity pneumonitis (HP) involves both identifying and removing the antigen that’s causing the condition, and taking anti-inflammatory medication. […] If the inhaled antigen can be recognized and removed, the lung inflammation in acute HP is often reversible. […] If you don’t improve or continue to worsen, we may recommend anti-inflammatory medications. Prednisone is the mainstay of medication therapy and is often very effective. […] In addition to medications and removal of the antigen, pulmonary rehabilitation a structured exercise and educational program designed for patients with chronic lung disease is an important and effective treatment for patients with chronic HP. […] Lastly, lung transplant may be an effective treatment option for some patients.

• #28 Hypersensitivity pneumonitis (extrinsic allergic alveolitis): Treatment, prognosis, and prevention – UpToDate

  https://www.uptodate.com/contents/hypersensitivity-pneumonitis-extrinsic-allergic-alveolitis-treatment-prognosis-and-prevention

  Hypersensitivity pneumonitis (HP), also called extrinsic allergic alveolitis, is a syndrome characterized by diffuse inflammation of lung parenchyma and airways in response to the inhalation of antigens to which the patient has been previously sensitized. Numerous inciting agents have been described including, but not limited to, agricultural dusts, bioaerosols, and certain reactive chemical species. […] Both environmental and host factors are involved in the production of the HP syndromes, so management theoretically can involve modification of the environment or of the host immune response. As the pathogenesis of HP is incompletely understood, emphasis on environmental control remains the cornerstone of therapy. The treatment, prognosis, and prevention of HP will be reviewed here. […] Antigen avoidance is the cornerstone of treatment for symptomatic HP and usually results in regression of disease. Additional treatment may be required in more severe or progressive disease. The best studied forms of HP are farmer’s lung and bird fancier’s lung; treatment of other types of HP largely is extrapolated from the experiences in these populations.

• #29 What is hypersensitivity pneumonitis? | Action for Pulmonary Fibrosis

  https://www.actionpf.org/information-support/hypersensitivity-pneumonitis

  Early and accurate diagnosis is important to ensure removal of the source of the dust or allergen (for example removal of birds, wearing filtration face mask at work, changing job). […] Acute hypersensitivity pneumonitis is usually treatable if correctly diagnosed and there is no more exposure to the antigen. However, in many cases it cannot be identified. […] Chronic hypersensitivity pneumonitis is a long-term condition. You may need to take steroids or other immunosuppressive therapies to reduce the inflammation in your lungs. […] You may need oxygen therapy and pulmonary rehabilitation. You may also be prescribed medications to help manage your cough. […] Some patients with chronic hypersensitivity pneumonitis may also be considered for lung transplantation.

• #30 Hypersensitivity Pneumonitis Treatment | National Jewish Health

  https://www.nationaljewish.org/conditions/hypersensitivity-pneumonitis/treatment

  Treatment involves identifying and avoiding the exposure that is causing the disease. […] Glucocorticoids such as prednisone that have anti-inflammatory effects may be used to treat severe acute or worsening chronic hypersensitivity pneumonitis. […] Inhaled steroids such as those used for asthma can sometimes help people with HP. […] In some cases, immunosuppressive therapies, which decrease the body’s immune response, may stabilize or reverse the lung inflammation of HP.

• #31 Drug-Induced Pneumonitis | Ohio State Medical Center

  https://wexnermedical.osu.edu/lung-pulmonary/ohio-states-lung-center/interstitial-lung-disease/drug-induced-pneumonitis

  Sometimes certain medications can lead to lung inflammation called drug-induced pneumonitis. […] Drug-induced pneumonitis is a type of interstitial lung disease (ILD) caused by certain medications you might be taking. […] Since this inflammation can lead to difficulty breathing, its important to identify the cause and find alternatives to the drugs or medical treatments responsible for it. […] Although drug-induced pneumonitis is treatable, it can leave permanent damage and scarring in the lungs if not caught early. […] Thats why its important to work with a team of interstitial lung disease specialists, like the ones at The Ohio State University Wexner Medical Center, to diagnose and treat your drug-induced pneumonitis. […] If its determined you have chemical pneumonitis, well recommend you stop taking the medication thats irritating your lungs and work to find alternatives to it. Eliminating exposure to the drug should ease symptoms.

• #32

  https://link.springer.com/article/10.1007/s11864-024-01257-6

  Drug-induced pneumonitis is a common adverse event that may occur during lung cancer systemic therapy. […] In most cases, stopping the offending drug and use of corticosteroids is the sufficient treatment; however, patients with more severe forms of pneumonitis require additional immunosuppressive agents. […] Management of TIP is dependent upon severity and initial steps should include holding further treatment with the offending taxane. […] The use of corticosteroids is the mainstay of treatment for patients with TIP who have more moderate to severe respiratory compromise. […] Management of HER2-targeted ADC-related pneumonitis is similar to that of TIP. Corticosteroids are the mainstay of treatment and the manufacturers of the most common ADC, T-DXd, have specific management discussed in their trial protocol for pulmonary toxicity.

• #33 Drug-Induced Pneumonitis | Ohio State Medical Center

  https://wexnermedical.osu.edu/lung-pulmonary/ohio-states-lung-center/interstitial-lung-disease/drug-induced-pneumonitis

  For severe cases of pneumonitis, your doctor might treat you with corticosteroids (such as prednisone) to reduce the inflammation in your lungs. Oxygen therapy can also help with symptoms and make breathing easier. […] Here at the Ohio State Wexner Medical Center, we have an interstitial lung disease program with staff dedicated to caring for and treating people with these types of pulmonary conditions.

• #34 Drug-Related Pneumonitis in Cancer Treatment during the COVID-19 Era

  https://www.mdpi.com/2072-6694/13/5/1052

  Interstitial lung disease is recognized as a group of diseases with a different etiopathogenesis characterized by chronic lung inflammation with the accumulation of inflammatory cells, lymphocytes and macrophages, and the consequent release of proinflammatory cytokines. […] The prompt diagnosis of drug-related pneumonia and the consequent differential diagnosis with other forms of pneumonia allow a rapid suspension of treatment and the establishment of an immunosuppressive treatment if necessary. […] The cornerstone of drug-induced pneumonitis treatment are corticosteroids, since the underlying mechanism of lung damage is the inflammatory and/or the immunological process. […] In severe cases, with the failure of high-dose steroid therapy, often the evolution to pulmonary fibrosis occurs, which may require other biological or immunosuppressive agents, such as cyclophosphamide, mycophenolate mofetil, azathioprine, infliximab, tocilizumab or rituximab.

• #35 Pneumonitis With Immunotherapy Treatment | Oncology Nursing Society

  https://www.ons.org/publications-research/voice/news-views/09-2019/pneumonitis-immunotherapy-treatment

  For grade 3 and 4 pneumonitis, permanently discontinue immunotherapy. However, in grade 3 pneumonitis, consider rechallenge on a case-by-case basis under close observation. Hospitalize patients and treat with empirical antibiotics and IV methylprednisolone IV 12 mg/kg per day, tapering over four to six weeks.

• #36 Pneumonitis With Immunotherapy Treatment | Oncology Nursing Society

  https://www.ons.org/publications-research/voice/news-views/09-2019/pneumonitis-immunotherapy-treatment

  Pneumonitis is inflammation of the lung parenchyma; although rare, it can be fatal. Nishino et al. found that the overall incidence of pneumonitis with PD-1 inhibitor monotherapy was 2.7% for all-grade and 0.8% for grade 3 or higher pneumonitis. […] Naidoo et al. reported an approximate 5% incidence of all-grade pneumonitis, although the incidence of all-grade pneumonitis is higher with combination immunotherapy (up to 10%). The incidence is more common with higher grades in PD-1 inhibitors (versus PD-L1 inhibitors), but it occurs less often with anti-CTLA4 monoclonal antibodies. […] Grade 1 immune-related pneumonitis is managed with close observation and consideration of holding immunotherapy. […] Grade 2 pneumonitis requires that immunotherapy be held until resolution to grade 1 or less. Administer prednisone 12 mg/kg per day, tapering by 510 mg per week over four to six weeks after it improves to less than grade 2.

• #37 Pneumonitis From Anti–PD-1/ PD-L1 Therapy

  https://www.cancernetwork.com/view/pneumonitis-antipd-1-pd-l1-therapy

  Restarting immune checkpoint inhibitors can be considered if the pneumonitis initially presents as grade 2, and within a few days of initiation of pneumonitis management is downgraded to grade 1, without recrudescence of symptoms after corticosteroid taper. […] After the diagnosis of pneumonitis has been made, this toxicity must be graded and treated based on the CTCAE-defined grade. Broadly, grade 1 pneumonitis can be treated by withholding immune checkpoint inhibitors and by careful clinical observation. […] Patients with grade 2 pneumonitis (symptomatic pneumonitis) should receive prednisone, 0.51 mg/kg/d, or the equivalent, and patients with grade 3 pneumonitis should receive a higher dose: 12 mg/kg or the equivalent. […] If there is clinical improvement within a few days of implementation of this course of management, a 4- to 6-week corticosteroid taper may be completed.

• #38 Radiation pneumonitis | Canadian Cancer Society

  https://cancer.ca/en/treatments/side-effects/radiation-pneumonitis

  Radiation pneumonitis is inflammation of the lungs caused by radiation therapy to the chest. It often starts in the first few months after treatment is over, but it can start up to 12 months after treatment. […] Your healthcare team may recommend different treatments for radiation pneumonitis. These include: cough suppressants to lessen your cough, bronchodilators to help open your airways, corticosteroids to reduce inflammation, oxygen therapy to improve your breathing. […] You can also try the following to help manage symptoms: Rest if you feel short of breath. Use an extra pillow to raise your head and upper body while resting or sleeping. Avoid being outside on hot, humid days or very cold days. Extreme temperatures can irritate the lungs. Wear light, loose-fitting tops. Avoid anything tight around the neck, such as ties or shirt collars.

• #39 Radiation pneumonitis

  https://www.eviq.org.au/clinical-resources/radiation-oncology/side-effect-and-toxicity-management/1895-radiation-pneumonitis

  Radiation pneumonitis can have considerable impact on patient morbidity, including a patients quality of life and respiratory function. However, it usually resolves if treated with corticosteroids. […] Corticosteroids depending on severity (e.g. prednisone; starting at 20 mg to 40 mg (PO) ONCE per day, in the morning, with food for 14 days then taper slowly over a minimum of 6 weeks). […] Pneumonitis due to infection should be considered as a differential diagnosis before starting patients on high dose steroids.

• #40 Aspiration Pneumonitis – Diagnosis & Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/aspiration-pneumonitis-diagnosis-treatment/

  Aspiration pneumonitis (AP) is lung inflammation caused by aspiration of gastric acid or other substances without bacterial infection. […] Should be differentiated from aspiration pneumonia, which is caused by bacteria and requires antibiotics. […] Uncomplicated AP does not require antibiotics. […] Patients may present with secondary bacterial pneumonia after the initial event. […] We recommend monitoring for deterioration or unexpected changes prior to use of antibiotics. […] Glucocorticoids not recommended. Multiple studies showing no benefit. […] Antibiotics not recommended in mild and moderate cases. Multiple studies showing no difference in outcomes.

• #41 Aspiration Pneumonitis and Pneumonia – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/pneumonia/aspiration-pneumonitis-and-pneumonia

  Treatment of aspiration pneumonitis is supportive, often involving supplemental oxygen and mechanical ventilation. Antibiotics are often are given to patients with witnessed or known gastric aspiration; however, studies have not supported this practice. A preferred approach is close observation with antibiotics being prescribed if the clinical course suggests subsequent bacterial superinfection. Early empiric antibiotics can also be stopped if patients improve rapidly. […] For aspiration pneumonia, a beta-lactam/beta-lactamase inhibitor is recommended; moxifloxacin or clindamycin is reserved for use in patients who are allergic to penicillin. If aspiration occurs in the hospital setting, a carbapenem or piperacillin/tazobactam can be used; medications effective against MRSA are added if risk factors for that pathogen are present. Duration of treatment is usually 1 week.

• #42 Chemical pneumonitis: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000143.htm

  Treatment is focused on reversing the cause of inflammation and reducing symptoms. Corticosteroids may be given to reduce inflammation, often before long-term scarring occurs. […] Antibiotics are usually not helpful or needed, unless there is a secondary infection. Oxygen therapy may be helpful. […] In cases of swallowing and stomach problems, eating small meals in the upright position can help. In severe cases, a feeding tube in the stomach is needed, although this does not always completely prevent aspiration into the lungs.

• #43 Hypersensitivity Pneumonitis: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17898-hypersensitivity-pneumonitis

  Lung transplant. If your HP progresses to pulmonary fibrosis, you may need a lung transplant. […] It can take several months for your lungs to heal from the inflammation HP causes. Some damage can be permanent. […] You usually cant get rid of chronic hypersensitivity pneumonitis. Acute and subacute HP can go away on its own or with medication if you arent exposed to the allergen anymore.

• #44 Immune checkpoint inhibitor therapy‑related pneumonitis: How, when and why to diagnose and manage (Review)

  https://www.spandidos-publications.com/10.3892/etm.2024.12670

  In refractory cases or those with severe pneumonitis, additional immunosuppressive agents such as infliximab or mycophenolate mofetil may be considered, although their efficacy remains uncertain. […] Collaborative efforts between oncologists, pulmonologists and rheumatologists are essential in optimizing patient outcomes and minimizing treatment-related complications.

• #45 Pneumonitis associated with pembrolizumab plus chemotherapy for non-squamous non-small cell lung cancer | Scientific Reports

  https://www.nature.com/articles/s41598-023-30676-y

  Based on these results, patients with worsening of respiratory status may need to be considered for a more intense immunosuppressive approach, and more attention should be paid to early-onset pneumonitis. […] In conclusion, this study demonstrated that the CTCAE grade of pneumonitis, the pattern of the images, and the extent of pneumonitis were important factors that influenced the clinical course. In addition, in this study, we showed that the worsening of respiratory status during the treatment was associated with a poor prognosis. Further, some patients experienced relapsed pneumonitis during the hold of the therapy or after the rechallenge. Given the small number of trials for pneumonitis, the results of this study will serve as a basis for conducting future studies to investigate treatment strategies for these patients and consider more appropriate management guidelines.

• #46 Pneumonitis: Symptoms, Causes, and Treatments

  https://resources.healthgrades.com/right-care/lungs-breathing-and-respiration/pneumonitis

  Pneumonitis can resolve on its own if you remove or avoid the offending irritant. However, long-term inflammation can lead to scarring and permanent lung damage called pulmonary fibrosis. This can occur when pneumonitis continues unnoticed or untreated. Pulmonary fibrosis can cause high blood pressure in the lungs, heart failure, and, in extreme cases, respiratory failure that can lead to death. […] There are many treatment options available for pneumonitis, including avoidance or elimination of the initial cause, as well as clinical treatment to improve symptoms and adverse effects of the condition.

• #47 Hypersensitivity Pneumonitis Types, Causes, Symptoms, Treatment

  https://www.medicinenet.com/hypersensitivity_pneumonitis/article.htm

  What is the treatment for hypersensitivity pneumonitis? The most important treatment of hypersensitivity pneumonitis is avoidance of repeated exposures to the offending particles. With early diagnosis and prevention, the prognosis is good. […] Prolonged, repeated exposures can lead to permanent lung damage, scarring, and potentially significant disability.

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